Another Infertility Cause: Fear Of the Unknown

One of the most distressing comments I hear regularly in my office: “Dr. Kristiansen, I cannot believe I waited so long to seek help getting pregnant. Now that so much time has passed, I hope I can still get pregnant!”

Why am I writing about this? Because we know from studies that a big percentage of men and women avoid seeking fertility treatment because they're afraid. If you've already taken that big first step of scheduling a fertility consultation, you know exactly what I mean. People who are starting to worry about why they haven't gotten pregnant scour the Internet for reasons and solutions, and what they see can scare them away from the very thing that could result in pregnancy.

Image(s): FreeDigitalPhotos.net

Here's what I want them to know: An initial consultation with a fertility specialist does not equate to treatment, but it can often add up to more informed women and men who go on to “get it right,” with or without treatment.

What are they afraid of?

Intimacy issues – Who wants an audience to be in on your private dreams of building a family? It's hard enough to discuss with loved ones, but talking to a professional can make you feel even more uncomfortable. Fortunately, I can tell you that my staff at Houston Fertility Center are all long-timers in this medical arena. We understand, in some cases from personal experience, the emotional discomfort that you're going through. Your concerns are treated with utmost dignity and discretion.

Medical procedures – Most fertility patients are of average health and have never gone through any kind of treatment process beyond an occasional round of antibiotics for infection. It's understandable that virtually any medical tests or treatments might seem scary. Many are under the mistaken impression that IVF is the only kind of treatment. Again, simply talking with a fertility specialist does not necessarily include any tests or procedures. That said, a lot of first-time patients do agree that scheduling their initial consultation on Day 3 of the woman's cycle, and undergoing a simple blood draw to determine levels of reproductive hormones, can save time and money in the getting-pregnant process. It's your choice.

Financial costs – It's true that once you decide to become a fertility patient, there will be some costs involved. The financial expenses will vary from patient to patient, depending on health care coverage (or not) and on the causes that are determined to be your own fertility obstacle. Treatment costs vary widely and, actually, most patients do not need IVF to get pregnant. The majority of patients can become pregnant with less costly forms of treatment, like IUI (intrauterine insemination). (I'll address the differences in an upcoming blogpost.) But no one can tell you what your costs will be until thorough diagnostics have been implemented, and you have had a chance to discuss the options.

The important point: There's no way that your research alone or even any online-only consultations can adequately review and assess your fertility status and sum up whatever issues might need to be addressed for you to get pregnant.

Don't let fear of the unknown be your own major obstacle to getting pregnant.

Saving Your Nest Eggs For A Rainy Day

Chances are good you've heard of oocyte cryopreservation – in plain language, egg freezing – as a way for women with cancer to preserve their fertility just prior to undergoing chemotherapy or radiation treatments. But did you know that women without cancer can also choose to freeze their egg cells?

It's becoming more common for women – who are now far more savvy about fertility than past generations – to make use of their highly-informed foresight in family planning and opt for freezing their eggs, well in advance of when they plan to conceive.

Image:FreeDigitalPhotos.net

The technology used to freeze and thaw oocytes has rapidly advanced to be more reliable and effective, resulting in greater success rates. So more fertility centers are offering this option to women whose goals are simply to “freeze in place” their fertility. For example, women in their 20's who are super-busy with academic and career goal tasks might envision motherhood for their 30's. These same well-informed women also know that their chances at natural conception decrease with age. So far, it appears that freezing an egg cell now – in its healthiest condition – can result in thaw, conception, and pregnancy success several years down the road.

Many specialists -- including my own lab staff at Houston Fertility Center -- see the greater possibilities for use of egg freezing in this way, to preserve the family-building options for fertile women. I can't tell you how many times I've heard in my office, “Dr. Kristiansen, I cannot believe I spent all those years using contraceptives and trying NOT to get pregnant – and now when I want to, I can't!” For some of these patients, if egg freezing had been available, they could've continued with their contraceptive efforts until the time was right – as late as their 30's or 40's – and their eggs, frozen while still young, would be ready and waiting to be used to create embryos.

Perhaps egg freezing will eventually become just part of the normal course of reproductive health care management that young women learn about and use for wise family-planning.


~Dr. Sonja Kristiansen MD

Can You Have Too Much Information in Fertility Treatment?

Like many of my patients, my life revolves around information. Personally, I use the same technology as most of you to keep track of obligations and loved ones. Professionally, the Houston Fertility Center team uses technology and constant communication to manage our patients' treatment plans. In this era of digital info, we can all feel more empowered, more often, more quickly. It seems like there's always room for more information, doesn't it?

Is it possible we sometimes actually don't help things with our "more is better" attitude toward information?

It's quite common in my office to hear, "Dr. Kristiansen, we want a baby so badly, we'll submit to any test that exists to find out the problem." I applaud their desire to get to the root of the situation and make it better. For many patients, the "not knowing" is nearly as difficult as not having a baby.

Ironically, even when I have strong reasons to suspect a particular cause of a patient's infertility, some may feel very unsettled if I order only those tests that I know will hone in on that cause. I understand -- they want to cover every single realm of possibility, right up front, leave no stone unturned (so to speak), even if it means performing tests that have a low chance of being applicable in their situation.

Recently, an organization published fact sheets called "Five Things Physicians and Patients Should Question," authored by nine medical specialty societies such as the American Academy of Family Physicians and others. The point of this public information campaign: to encourage patient-doctor communication about eliminating unnecessary tests and procedures. The campaign was first started by the National Physicians Alliance and then further supported by the ABIM Foundation with a focus on evidence-based medicine.

There are two recommendations that are pertinent to gynecology:

1. Don't perform Pap smears on women younger than 21 or who have had a hysterectomy for non-cancer disease.
2. Don't recommend follow-up imaging for clinically inconsequential adnexal cysts. 

However, there are no similar recommendations specific to fertility treatment.

If you're trying to get pregnant and are worried there may be a problem, here are the tests that I recommend for virtually any fertility patient:

• Medical history: Not exactly a "test" but a good review of your health and even a little about your immediate family's health history can give us a lot of clues.

• Semen analysis: It really does take two, so there's almost no point in only looking for infertility causes in half of a couple.

• Pelvic exam: Even if you've had annual well-woman exams for years, it's possible that something's been missed or that things have changed in terms of your reproductive structure.

• HSG, unless you're using IVF: Hysterosalpingogram is the best way to determine tubal patency. If there's not a definite plan for in vitro fertilization (which is a very successful workaround for tubal factor infertility), then we need to know the pathway for your eggs is clear.

• AMH & Day 3 FSH: Simple blood tests, testing these two hormones give us a wealth of information about the quantity and quality of your eggs, for patients of all ages, and enables us to start your treatment plan most appropriately. There's no point being caught by surprise later down the line by an ovarian reserve that was in decline all along.

Of course, there are more diagnostic tools at our disposable if necessary. And that's my point: Simply having a wider array of tests and procedures does not make them all necessary. So why go through the expense of both time and money, not to mention additional anxiety, by submitting to every test -- unless we find, one step at a time, that your initial tests aren't revealing enough information to optimize your treatment path.

Can we have too much information? Not really, especially when it comes to our comfort level. We've all become very accustomed to the sense of control over our lives that comes from having all that data. But there are costs to being inundated with data, both financially and emotionally. Part of my job as a fertility specialist is helping patients find what's necessary and truly helpful from among the abundant but sometimes confusing options.

(Image: Jeroen van Oostrom | FreeDigitalPhoto)

"Big News" About New Eggs Is a Big Maybe

This week, a study published in the journal Nature Medicine is promising to scramble a long-held belief about women's eggs.

Scientists at Massachusetts General Hospital have isolated egg-producing stem cells from human ovary tissue. Then, in laboratory conditions, the cells eventually resulted in new egg cells.

Image: Carlos Porto / FreeDigitalPhotos.net

It's the big health news du jour. (So I'm sure my inbox will fill with hopeful "Dr. Kristiansen, did you see the news?!")

For years now, we've all believed that females are born with the most eggs they'll ever have and that when the number dwindles down, natural infertility is the result. This new finding is exciting in terms of possibilities for related infertility treatments.

But good research takes time. Often, a very long time.

Do you recall when we started learning more than a decade ago that, contrary to long-held beliefs, human brains can generate new cells? It's very exciting to consider people with brain injury may be able to recover more fully! But now, many years of research later, experts in neuroscience are skeptical again.

There are still far more questions that must be addressed before this knowledge about "new" egg cells is usable by fertility specialists in helping women with age-related infertility or premature ovarian aging. In fact, I'd bet that the necessary details will come too late to institute a related plan for any woman who is currently considering fertility treatment. For those who want to delay conception but take advantage of their youthful fertility, the best options remain egg or embryo freezing via IVF. And my team at Houston Fertility Center will be happy to serve you with those tried-and-true techniques, today.

Dear Valentine: Would You Take An At-Home Sperm Test?

Okay, it's not really the most romantic idea, so you may want to wait until a day or two later to ask, but getting your guy in on the diagnostic testing is a crucial piece of the infertility puzzle.

And now, he'll be able to test his sperm count at home. It's not the first product of its kind, but starting in April, it could be the only one on shelves of big drugstores like Walgreens and CVS, and it appears to be simpler to use. According to this article on Bloomberg.com, the makers are counting on "women dropping an extra $40 for the test when they buy ovulation and pregnancy kits for themselves."

Great idea, since it's true that most men aren't eager to jump with both feet into the fertility diagnostic effort. It's hard to blame them. But proceeding with fertility treatment having only searched for causes in the woman is like, well, getting a half-filled box of chocolates.

Still, $40 seems like a lot to drop on something that only gives you part of the picture anyway. Like its predecessors, SpermCheck Fertility tells you whether or not the sperm count is 20 million or more per millileter of semen, which is considered normal. That's all.

The test doesn't give users any information on the extremely important factors of morphology (sperm cell shape) or motility (movement), both of which can make or break a guy's capacity to play Cupid to your Valentine.

For just a slightly higher fee, you can get the whole big picture -- count, shape, and movement of the sperm cells -- and have a laboratory professional do the reading. (Do I get patient calls like this: "Dr. Kristiansen, I can't tell if I see a line on this OPK..."? Yes, I do.)

So, I can't advise you on whether or not to spend your money on this product, but if you do and find out that he's "normal" -- but you still don't get pregnant -- I *can* tell you that your continuing infertility is not necessarily, therefore, all on your shoulders. It's not uncommon to have a great sperm count but with a high percentage of cells that don't function well.

Fortunately, reproductive endocrinologists (like me) have plenty of ways around those issues. Please note: you won't find the most advanced treatments, like ICSI or TESE, available through OB/Gyns who aren't Board Certified in REI. In fact, just like shelling out the bucks for at-home tests that don't give you a full diagnostic result, trying to achieve pregnancy with male factor infertility through your OB/Gyn can be a money drain.

Besides, if the at-home sperm count test comes back "abnormal" your next step is heading to a physician anyway. I bet your sweetheart would far rather lob all of those arrows in one appointment. If he's sweet enough to participate in helping you have a baby, maybe you should bundle all of his related tasks into one romantic, hopeful day. The Houston Fertility Center staff is happy to help make your dreams real.

~ Dr. Sonja Kristiansen MD

Dragon Babies In the Making!

Surely, you've seen this recently? The Chinese New Year has arrived, and this year, deemed The Year of The Dragon by Chinese astrologers, is supposed to be especially auspicious for having babies.

The Wall Street Journal says that "dragon babies" -- those born from now until February 9, 2013 -- are supposed to be strong, smart, and lucky. Quite a combination! What parent wouldn't want those things for their child? Even if you think astrology is nothing more than silly fun...

But here's the modern twist on an ancient tale: Couples are actually taking advantage of assisted reproductive technology to boost their chances of getting pregnant with a Dragon Baby. In the article, one egg donation agency reports they've increased the number of donors with Chinese ancestry to prepare for an expected rise in intended parents.

What we're talking about here is a new kind of family planning, people taking full advantage of the availability and increasing reliability of fertility treatment success, even if there are no fertility problems. "But Dr. Kristiansen," you're wondering, "isn't IVF for fertile people going to extremes?" IVF is the most direct means of assisted conception for many people, but artificial insemination can work as well for some.

So if you want to have a Dragon Baby, you need to institute a plan and aim for conceiving by mid-May of this year. My staff at Houston Fertility Center will be happy to assist -- even if you think astrology is just for fun.

~ Dr. Sonja Kristiansen M.D.

Image: Naypong / FreeDigitalPhotos.net

Happy Holidays to The Non-Exclusive Club of Kindred Spirits

Virtually all of my patients at the Houston Fertility Center come in feeling alone, at least at the start of their fertility journey. Occasionally I receive "Dear Dr. Kristiansen" emails, mostly from women who live in fear that their situation, their particular cause of infertility, is rare and untreatable. And the holidays is by far the hardest time of year to have an overwhelming feeling of being left out in the cold. But things are a lot better now than in past years, when infertility truly wasn't something anyone talked about beyond clinic hallways.

In this blogpost for Huffington Post, author Leslie Goldman sums up the thoughts that run through so many patients' minds: "Why not me?!" Just as Leslie found out when she dared reveal her struggles with getting pregnant, there is in fact a huge number of people who are going through the same or similar. She finishes up her post with experienced advice for those who are still trying to conceive: "Drink wine. Lots and lots of wine. And enjoy it while you can."

For this holiday season, I encourage you to let things go a bit. If you're in the middle of an IVF cycle or other treatment, follow doctors' orders, of course, but also take advantage of every single opportunity allowed to enjoy yourself. Any questions about whether it's okay to do this or that in mid-cycle? Just ask. If you're not in the middle of treatment, then try your best to shelve the sense of urgency. Breathe as much as you can, both literally and figuratively. After the holidays, you can get right back on the path (if you want) or start thinking about new roads to travel.

But for now, I wish you all peace.

~ Dr. Sonja Kristiansen M.D.